Working conditions and well-being in UK social care and social work during COVID-19.

Summary: Stress and mental health are among the biggest causes of sickness absence in the UK, with the Social Work and Social Care sectors having among the highest levels of stress and mental health sickness absence of all professions in the UK. Chronically poor working conditions are known to impact employees' psychological and physiological health. The spread of the COVID-19 pandemic has affected both the mode and method of work in Social Care and Social Work. Through a series of cross-sectional online surveys, completed by a total of 4,950 UK Social Care and Social Workers, this study reports the changing working conditions and well-being of UK Social Care and Social Workers at two time points (phases) during the COVID-19 pandemic. Findings: All working conditions and well-being measures were found to be significantly worse during Phase 2 (November-January 2021) than Phase 1 (May-July 2020), with worse psychological well-being than the UK average in Phase 2. Furthermore, our findings indicate that in January 2021, feelings about general well-being, control at work, and working conditions predicted worsened psychological well-being. Applications: Our findings highlight the importance of understanding and addressing the impact of the pandemic on the Social Care and Social Work workforce, thus highlighting that individuals, organizations, and governments need to develop mechanisms to support these employees during and beyond the pandemic.

Enhancing slow wave sleep with sodium oxybate reduces the behavioral and physiological impact of sleep loss.

STUDY OBJECTIVES: To investigate whether enhancement of slow wave sleep (SWS) with sodium oxybate reduces the impact of sleep deprivation. DESIGN: Double-blind, parallel group, placebo-controlled design SETTING: Sleep research laboratory PARTICIPANTS: Fifty-eight healthy adults (28 placebo, 30 sodium oxybate), ages 18-50 years. INTERVENTIONS: A 5-day protocol included 2 screening/baseline nights and days, 2 sleep deprivation nights, each followed by a 3-h daytime (08:00-11:00) sleep opportunity and a recovery night. Sodium oxybate or placebo was administered prior to each daytime sleep period. Multiple sleep latency test (MSLT), psychomotor vigilance test (PVT), Karolinska Sleepiness Scale (KSS), and Profile of Mood States were administered during waking hours. MEASUREMENTS AND RESULTS: During daytime sleep, the sodium oxybate group had more SWS, more EEG spectral power in the 1-9 Hz range, and less REM. Mean MSLT latency was longer for the sodium oxybate group on the night following the first daytime sleep period and on the day following the second day sleep period. Median PVT reaction time was faster in the sodium oxybate group following the second day sleep period. The change from baseline in SWS was positively correlated with the change in MSLT and KSS. During recovery sleep the sodium oxybate group had less TST, SWS, REM, and slow wave activity (SWA) than the placebo group. CONCLUSIONS: Pharmacological enhancement of SWS with sodium oxybate resulted in a reduced response to sleep loss on measures of alertness and attention. In addition, SWS enhancement during sleep restriction appears to result in a reduced homeostatic response to sleep loss.

Pharmacologic management of insomnia: past, present, and future.

Views on the etiology and morbidities associated with insomnia are evolving and affect clinicians' approach to the pharmacologic management of insomnia. Currently, benzodiazepine receptor agonists (BzRAs) and a single melatonin receptor agonist are recognized as safe and efficacious hypnotics. Variability in BzRAs, pharmacokinetics, and manipulation of dose provide clinicians with options that meet the needs of most patients. Other drugs (eg, sedating antidepressants) also are used commonly in clinical practice to treat insomnia, but evidence is lacking to support this most cases. Improvement in managing insomnia will result from systematic research with these drugs, with drugs in development, and with novel uses, such as co-therapy.

A convenient expiratory positive airway pressure nasal device for the treatment of sleep apnea in patients non-adherent with continuous positive airway pressure.

BACKGROUND: While continuous positive airway pressure (CPAP) effectively treats obstructive sleep apnea (OSA), adherence to CPAP is suboptimal. The short-term efficacy of and adherence with a convenient expiratory positive airway pressure (EPAP) nasal device was evaluated in OSA patients non-adherent with CPAP. METHODS: Participants were OSA patients who refused CPAP or used CPAP less than 3 h per night. After demonstrating tolerability to the EPAP device during approximately 1 week of home use, patients underwent a screening/baseline polysomnogram (PSG1) and a treatment PSG (PSG2). Patients meeting prespecified efficacy criteria underwent PSG3 after about 5 weeks of EPAP treatment. RESULTS: Forty-seven of 59 eligible patients (80%) tolerated the device and underwent PSG1. Forty-three patients (27 m, 16f; 53.7±10.9 years) met AHI entry criteria and underwent PSG2. Mean AHI decreased from 43.3±29.0 at baseline to 27.0±26.7 (p<0.001) at PSG2. Twenty-four patients (56%) met efficacy criteria; their mean AHI was 31.9±19.8, 11.0±7.9, 16.4±12.2 at PSG1, PSG2, and PSG3, respectively (p<0.001, PSG1 vs. both PSG2 and PSG3). Mean Epworth Sleepiness Scale (ESS) scores were 12.3±4.8 at baseline, 11.1±5.1 at PSG1, and 8.7±4.4 at PSG3 (p=0.001 compared to baseline). Device use was reported an average of 92% of all sleep hours. CONCLUSIONS: The improvements in AHI and ESS, combined with the high degree of treatment adherence observed, suggest that the convenient EPAP device tested may become a useful therapeutic option for OSA.